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<br />COLORDO BOARD OF LAND COMMISSIONERS <br />620 Centennial Building <br />1127 Sherman Street, Suite 300 <br />Denver, CO 80203 <br />MINERAL ROYALTY REPORT <br />Lease Type LT GM GL GP QR UR CY PL GE GS DW OS OM (CIRCLE ONE) <br />'-;tote lease No. _GP3395 <br />:crUnt- Cc:nejoes <br />Lessee-Alamosa County <br />Subsection _SEQTR_Section(s)_4 <br />Product Pit Run <br />Original X Adjustment <br />Production Month & Year OCTOBER 2010 <br />Produced/Operated by <br />Town ship_36 Range_8 <br />Unit of Measure YD TN LB OZ BL QT (CIRCLE ONE) <br />Beginning Inventory Units Produced 2975 <br />cndiric Inventorv I Init.:;n1H <br />Selling Frice per Unit Gross Sales <br />Royalty Rate 0.30 ROYALTY DUE $892.50 <br />For Adjusted Reports, Previous Amount Paid $ <br />Advance Minimum Royalty Credit (if applicable) $ <br />ROYALTY PAID$ <br />I1` tir s? an adjustment, please explain <br />$892.50 <br />Contact Name-Phil West Telephone No. (719 ) _589-6262 <br />I certify that this is a true and correct statement of production sold, value received, and royalty <br />due the State of Colorado for the period indicated. <br />Authorized Signature & Title <br />Reporting Company Name_Alamosa County Road & Bridge Dept._ Payor Number-701 <br />Address 8663 S Cnty Rd 109 <br />Alamosa, CO 81101-9423 <br />and sworn to before me by <br />On tf i;: day of 20 <br />My Commission Expires 20 <br />Notary Public <br />Date: Stamp Land Board Use Only <br />Verf;ec' Receipt No. <br />Postcc <br />Notes: <br />S L/0702 <br />Date .